There are at least 10 hospices in the Savannah area. And though they differ in size — Living Care Hospice has 40 patients; Hospice Savannah has 200 — they share a philosophy: ensuring death with dignity and, in the days and months as death approaches, providing compassionate care.

That means “providing physical, emotional and spiritual care” in the time before death, said Nancy Sutton, area executive director of Gentiva Hospice in Savannah who has worked in hospice care for 17 years.

Added Maggie Bredeson, registered nurse and case manager at the for-profit Living Care Hospice in Savannah, “Hospice care is care that happens at the end of a life span — usually palliative, not aggressive care. It’s care that comforts the patient.”

And hospice care can mean celebrating the last days of life, said Debra Anthony Larson, CEO/president of the Savannah area’s largest hospice, nonprofit Hospice Savannah.

It’s a time for patients to get their affairs in order, she said, but it’s also a time to celebrate birthdays, experience pet therapy, music therapy, a massage and visits from Hospice Savannah’s volunteer beautician.

Sometimes young mothers who are dying of breast cancer have videotaped a message to their children, Larson said.

“And we’ve had patients get married in hospice,” she said.

“Hospice helps them die with dignity, meaningful dignity. Everyone deserves a great death,” said Ellen Bolch, owner/president of the THA Group, which provides management services to the nonprofit Island Hospice.

Under Medicare rules, a patient is eligible for hospice care when two doctors certify that, if the disease takes its expected course, he or she has six months or less to live, Larson said. The patient may continue to be eligible for hospice care beyond six months based on the physicians’ certification.

But there are a lot of misconceptions about hospice care, Sutton said.

For instance, “people think hospice is a place you have to go to,” she said. Actually, hospice care can be offered wherever the patient is — in an assisted living facility, a skilled nursing facility, a personal care home or in the hospital. Eighty to 90 percent of hospice care patients die at home, and most patients want to die at home, Sutton and other providers said.

Another misconception: “Back in the old, old days, the public’s concept (of hospice care) was the patient would be admitted immediately before death. People thought hospice care means dying right away,” Bredeson said. “That’s not the case, although some people still mistakenly think that,” she said.

Because of a doctor’s unwillingness to recommend hospice care — or their mistaken views of this care — patients often enter hospice much later than the six months they are entitled to, providers said.

“The average length of stay (at Hospice Savannah) is about 59 days,” Larson said. “We get late referrals. Physicians are referring later.”

“If we can get patients soon enough, we can offer more services,” Bredeson said.

Medicare requires that hospice care is delivered by a team: a doctor, a social worker, a chaplain, a registered nurse, a certified nursing assistant and a volunteer.

“Our chaplains provide spiritual support,” Larson said.

And volunteers can read to a patient, assemble a scrapbook of a patient’s life or just sit with the patient, holding his or her hand. A social worker can offer counseling, help patients cope with their finances and more. Also, the medical staff can deal with illnesses and ease the symptoms of dying such as pain and nausea.

“There’s no excuse these days that someone has to suffer,” Sutton said.

Medicare pays hospices a daily rate for each patient. That rate is set differently in each county. The per diem rate in Chatham County “varies from a low of $145 a day for routine health care and respite care to a high of $675 for continuous care and general inpatient level of care.

“That’s when you’re paying for round-the-clock care, usually when a patient is having a crisis and you’re trying to get a crisis under control,” Sutton said.

For the patient, most hospice expenses are free if they’re related to the terminal illness, Larson said. That means free medical care, free prescriptions, free medical supplies like dressings, free oxygen and free equipment such as wheelchairs and walkers. Also provided: free counseling for the patient and his family and bereavement counseling for the family up to 13 months after death.

If the patient is not covered by Medicare or Medicaid, private insurance may cover the expenses. If the patient has no insurance, “all hospices are required to provide hospice care to eligible patients regardless of the ability to pay for services, Sutton said. “That’s a Georgia regulation.”

Hospices do a lot of marketing — educating physicians and the general public through brochures, advertisements, newsletters and more.

Larson called the market with so many hospices “very, very competitive.” One Hospice Savannah employee does nothing but talk to physicians, Larson said.

Gentiva’s Sutton agreed that the market is competitive.

“There are a lot of hospices out there asking for referrals from the health care community. But some are smaller, locally owned hospices that don’t follow the regulations. They end up not getting paid (by Medicare) and they can’t stay in business,” Sutton said.

And in the beginning

The word “hospice” comes from the Latin word “hospes,” the same root word from which “hospitality” was derived.

“Hospice” was used in the 1800s to describe the care of dying patients. It was used again by a nurse and medical social worker, Dame Cicely Saunders who founded a model facility, St. Christopher’s Hospice, in England in 1965. Students and officials at Yale University, inspired by a speech Saunders made there, reportedly started the hospice movement in the U.S.

By the late 1970s, more than 90 hospices had been started in the country. Today, there are reportedly, more than 3,200 in the U.S., Puerto Rico and Guam.

According to Hospice Savannah’s official history, its origin may have come because of comments made to the Savannah Morning News by Memorial Medical Center chief radiologist David E. Tanner. In an interview with the newspaper, Tanner lamented that “I saw so many dying patients who had nowhere to go.”

His comments inspired leaders in the Georgia Medical Society, the Combined Public Health Services Committee and the United Way Health Council to establish a community hospice. Hospice Savannah began in 1979 in a small office in the Senior Citizens building on Bull Street and was staffed entirely by volunteers, Larson said.

Today Hospice Savannah is southeast Georgia’s oldest hospice. It has a staff of 150 and 150 volunteers, and it serves patients in five south Georgia counties — Chatham, Effingham, Bryan, Liberty and Long.

In addition to administrative offices on Chatham Parkway, it runs the home-like “Hospice House,” a 28-bed in-patient facility on Eisenhower Drive where patients with medical problems can stay. Also dying patients stay there to give their caregivers respite care — time off from their 24-hour-a-day unpaid job.

In addition, Hospice Savannah has Full Circle, on Business Center Drive off Chatham Parkway, which offers free education and counseling to any adult or child in the Coastal Empire.

Hospice Savannah’s new building, located on Business Center Drive, is the home of the Edel Caregiver Institute. Starting this fall, the institute will provide support groups for caregivers and practical classes — learn “what to expect as your loved one’s disease progresses,” how to transfer a patient from bedside to a chair, how “to avoid caregiver burnout” and more, according to a handout about the institute.

The hospice runs other support groups in its Demere Center for Living, including one for bereaved spouses and Grief 101, a seven week grief therapy course. Also, Hospice Savannah runs Camp Aloha, a weekend camp for children who’ve lost a loved one. And starting in August, the hospice has a new, one-day family camp.

In all, Larson said, “Hospice is not a sad place … Hospice is more than the final days of care.”